obstructive jaundice

jaundice

[jawn´dis]

yellowness of skin, sclerae, mucous membranes, and excretions due to hyperbilirubinemia and deposition of bile pigments. It is usually first noticeable in the eyes, although it may come on so gradually that it is not immediately noticed by those in daily contact with the jaundiced person. Called also icterus.

Jaundice is not a disease; it is a symptom of a number of different diseases and disorders of the liver and gallbladder and of hemolytic blood disorders. One such disorder is the presence of a gallstone in the common bile duct, which carries bile from the liver to the intestine. This may obstruct the flow of bile, causing it to accumulate and enter the bloodstream. The obstruction of bile flow may cause bile to enter the urine, making it dark in color, and also decrease the bile in the stool, making it light and clay-colored. This condition requires surgery to remove the gallstone before it causes serious liver injury.

The pigment causing jaundice is called bilirubin. It is derived from hemoglobin that is released when erythrocytes are hemolyzed and therefore is constantly being formed and introduced into the blood as worn-out or defective erythrocytes are destroyed by the body. Normally the liver cells absorb the bilirubin and secrete it along with other bile constituents. If the liver is diseased, or if the flow of bile is obstructed, or if destruction of erythrocytes is excessive, the bilirubin accumulates in the blood and eventually will produce jaundice. Determination of the level of bilirubin in the blood is of value in detecting elevated bilirubin levels at the earliest stages before jaundice appears, when liver disease or hemolytic anemia is suspected.

Patient Care. Assessment of the patient with jaundice includes observations of the degree and location of yellowing, noting the color of urine and stools, and the presence of itching. Since jaundice can be accompanied by severe itching, frequent skin care is important to preserve skin integrity. Tepid sponge baths can help reduce discomfort and promote rest.

Patients with severe jaundice are at risk for encephalopathic changes that produce confusion, impaired mentation, and altered levels of consciousness. The potential for injury is increased and demands vigilance and safety measures to protect the patient.

Jaundice may be attributable to prehepatic (A), hepatic (B), or posthepatic (C) causes. From Damjanov, 2000.

acholuric jaundice jaundice without bilirubinemia, associated with elevated unconjugated bilirubin that is not excreted by the kidney. Familial acholuric jaundice is another name for the hereditary form of hemolytic jaundice.

breast milk jaundice elevated unconjugated bilirubin in some breast-fed infants due to the presence of an abnormal pregnane that inhibits glucuronyl transferase conjugating activity.

cholestatic jaundice that resulting from abnormality of bile flow in the liver.

ob·struc·tive jaun·dice

obstructive jaundice

obstructive jaundice

Hepatology Jaundice due to obstruction of the flow of bile through the cystic duct into the ampulla of Vater and thence into the small intestine. See Jaundice.

ob·struc·tive jaun·dice

(ŏb-strŭk'tiv jawn'dis)

Hepatic disorder resulting from obstruction to the flow of bile into the duodenum, whether intra- or extrahepatic. Synonym(s): mechanical jaundice.

obstructive jaundice

JAUNDICE caused by any process in the liver or bile ducts that prevents the normal outflow of bile. Obstructive jaundice is commonly caused by GALLSTONES (large duct obstruction) or a cancer of the head of the PANCREAS, or by disease processes that occlude the small bile ducts within the liver, such as HEPATITIS and CIRRHOSIS (small duct obstruction). Unrelieved obstruction causes ever-deepening jaundice.

ob·struc·tive jaun·dice

(ŏb-strŭk'tiv jawn'dis)

Hepatic disorder resulting from obstruction to the flow of bile into the duodenum, whether intra- or extrahepatic. Synonym(s): mechanical jaundice.

jaundice

yellowness of skin, sclerae, mucous membranes, and excretions due to hyperbilirubinemia and deposition of bile pigments. Called also icterus. It is usually first noticeable in the sclera.

The pigment causing jaundice is called bilirubin. It is derived from hemoglobin that is released when erythrocytes are hemolyzed and therefore is constantly being formed and introduced into the blood as worn-out or defective erythrocytes are destroyed by the body. Normally the liver cells absorb the bilirubin and secrete it along with other bile constituents. If the liver is diseased, or if the flow of bile is obstructed, or if destruction of erythrocytes is excessive, the bilirubin accumulates in the blood and eventually will produce jaundice. Determination of the level of bilirubin in the blood is of value in detecting elevated bilirubin levels at the earliest stages before jaundice appears, when liver disease or hemolytic anemia is suspected.

Jaundice in a horse's oral mucosa. By permission from Knottenbelt DC, Pascoe RR, Diseases and Disorders of the Horse, Saunders, 2003

acholuric jaundice

jaundice without bilirubinemia, associated with elevated unconjugated bilirubin that is not excreted by the kidney.

cholestatic jaundice

that resulting from abnormality of bile flow in the liver.

hematogenous jaundice

hemolytic jaundice.

hemolytic jaundice

jaundice associated with hemolytic anemia in which most of the bilirubin is unconjugated. Called also retention jaundice, prehepatic jaundice.

hemorrhagic jaundice

leptospirosis.

hepatocellular jaundice

jaundice caused by injury to or disease of the liver cells.

jaundice index

see icteric index.

nonhemolytic jaundice

that due to an abnormality in bilirubin metabolism.

obstructive jaundice

that due to blockage of the flow of bile, resulting in conjugated hyperbilirubinemia. Called also regurgitation jaundice.

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